Physical Therapist Training, Expertise, and Specialities

Physical therapists (PTs) are licensed allied health professionals who can treat patients with injuries or medical problems that limit their ability to move or function in daily life. They design and implement treatment plans that may involve a combination of exercise, hands-on therapies, and specialized procedures like ultrasound, electrical stimulation, and traction.

Physical therapists, known as physiotherapists in some countries, may also work with people to prevent injuries. To become a physical therapist, a person must undergo three years of training to attain a Doctor of Physical Therapy (DPT) degree. Some PTs undergo further training to specialize in fields like geriatrics, neurology, or sports medicine.

What Do Physical Therapists Do?

Physical therapists are trained to examine, diagnose, and treat people of all ages, from newborns to people at the end of their lives, who have injuries, disabilities, or other health conditions that need treatment.

By working with a PT, people may be able to:

• Better manage pain and chronic conditions
• Avoid or delay surgery or prescription medication
• Improve mobility, daily function, and quality of life
• Improve physical fitness and function
• Prevent future problems

PTs do so by examining each patient and developing a treatment plan based on in-office evaluations, such as the lower extremity functional scale (LEFS), neck disability index (NDI), Oswestry disability index (OSI), and others.

Once the treatment plan is implemented, the PT will monitor and adjust the treatment plan as needed. Physical therapy can be performed in a variety of settings, including private offices and clinics, hospitals, patients’ homes, and nursing homes.

While people can see a PT without obtaining a doctor's referral, referred to as "open access," PTs have limitations in what they can and cannot do and are not meant to replace a physician in most circumstances.

For instance, PTs are not qualified to diagnose diseases but can perform assessments to diagnose how a medical condition impacts mobility, flexibility, or strength. They also cannot prescribe medications or perform surgery.

What Can PTs Treat?

The American Physical Therapy Association (APTA) lists nearly 140 symptoms and conditions that physical therapists are trained to treat, including:

• Amputations
• Anterior cruciate ligament (ACL) tears
• Arthritis, including osteoarthritis and rheumatoid arthritis
• Back pain
• Carpal tunnel syndrome
• Certain headaches
• Chronic bursitis or tendinitis
• Fractures
• Joint dislocation
• Joint replacement
• Knee pain
• Lymphedema
• Muscular dystrophy
• Neurodegenerative disorders, like Parkinson's disease or multiple sclerosis
• Osteoporosis
• Pelvic floor disorders
• Rotator cuff tears
• Ruptured Achilles tendon
• Sciatica
• Spinal cord injury
• Sports injuries
• Stroke

What It Takes to Become a PT

There are several degrees a physical therapist may hold. Before the end of the 1990s, only a bachelor's degree in physical therapy was required. Students entering the field today are required to have a doctorate degree known as the Doctor of Physical Therapy (DPT) degree.

DPT programs typically last three years and require admission to a school accredited by the Commission on Accreditation in Physical Therapy Education (CAPTE).

Many DPT programs require a bachelor’s degree for admission with prerequisite undergraduate studies in anatomy, physiology, biology, chemistry, and physics. Other schools combine bachelor's degree and DPT training in a six- to seven-year program.

All states require PTs to be licensed. This involves passing the National Physical Therapy Examination administered by the Federation of State Boards of Physical Therapy (FSBPT).

Continuing education is required for PTs to keep their licenses. Although many PTs seek certification from the American Board of Physical Therapy Specialties (ABPTS), PTs are not required to be certified to practice in a specific area.

According to the Bureau of Labor Statistics, roughly 259,200 people were practicing as physical therapists in the United States in 2023. The number of PTs is expected to increase by around 14% by 2033.

Procedural Expertise

Physical therapists are movement experts, and exercise is one of the primary tools used to help you move and feel better. This includes therapeutic exercises such as stretches, isometric exercises, resistance band training, and weight training.

In addition, they may use other interventions—called therapeutic modalities or physical modalities—to help you regain your normal functional mobility. Some of the more common of these include:

• Therapeutic ultrasound: The transmission of high- or low-frequency sound waves to muscles and surrounding tissue promotes relaxation and increases circulation to injured areas.
• Electrical stimulation: This is the use of a mild electrical current to increase muscle strength and promote circulation to aid with healing.
• Kinesiology taping: This special cloth tape, also known as K-tape, is applied to your body to decrease pain, improve circulation, or increase muscle awareness during rehabilitation.
• Transcutaneous electrical nerve stimulation (TENS): This is a small battery-operated machine that uses gentle electrical pulses to decrease pain.
• Light therapy: This involves the use of lasers and light-emitting diodes at a specific wavelength to treat chronic pain, ease inflammation, and promote wound healing.
• Massage therapy: A hands-on technique used to decrease tightness in muscles and surrounding tendons and ligaments.
• Phonophoresis: This involves the introduction of medications through your skin to underlying tissues using a specialized form of ultrasound.
• Iontophoresis: Another form of electrical stimulation that uses electrical pulses to push medication through the skin to affected muscles, tendons, or ligaments.
• Heat therapy: Also known as thermotherapy, this uses gentle heat to increase circulation to injured tissues, relax the muscles, reduce joint stiffness, and provide pain relief.
• Cold therapy: Also known as cryotherapy, this involves the application of cold to reduce inflammation and, with it, swelling and pain.
• Whirlpool therapy: This form of hydrotherapy (water therapy) delivers warm or cold swirling actions that improve circulation, maintain clean wounds, or control inflammation.
• Traction: This is a form of immobilization used to prevent movement of a limb or spine during recovery from an injury or surgery.
• Joint mobilization: This is when a PT passively moves a joint in specific directions to help decrease pain and improve mobility.
• Myofascial release: This is a gentle, constant massage that releases tightness and pain in myofascial tissues that provide support to muscles and bones.

Subspecialties

After licensing, some physical therapists choose to become board-certified specialists. To do so, the ABPTS requires at least 2,000 hours of clinical work in the specialty area within the past 10 years or the completion of an ABPTA-accredited residency program in the specialty area. Certification is achieved once you pass a certification exam.

The ABPTS certifies nine physical therapy specialties:

• Cardiovascular & pulmonary: This specialty provides cardiac rehabilitation for people who have chronic heart disease or have had a heart attack. Pulmonary rehabilitation is used for lung conditions like chronic obstructive pulmonary disease (COPD), cystic fibrosis, or sarcoidosis.
• Clinical electrophysiology: This specialty uses electrotherapy (a.k.a. electrical stimulation) to prevent blood clots, promote wound healing, relax muscle spasms, improve blood circulation, and alleviate pain. This includes the treatment of post-surgical wound healing and diabetic ulcers.
• Geriatrics: This specialty treats elderly people who have limited mobility or suffer chronic pain from arthritis or osteoporosis. They also help treat patients with progressive diseases such as Parkinson's disease or Alzheimer's disease that impact everyday activities.
• Neurology: This specialty treats disorders of the central and peripheral nervous systems, including those with brain or spinal cord injuries, multiple sclerosis, sciatica, neuropathy, fibromyalgia, and cerebral palsy.
• Oncology: This specialty works with people who have or are recovering from cancer. PTs can help manage symptoms of cancer or cancer treatment, including pain, muscle weakness, joint stiffness, numbness in feet and hands, and loss of bone density.
• Orthopedics: This involves treating conditions of the musculoskeletal system, including bones, muscles, ligaments, tendons, and joints. This includes conditions like arthritis, tendon tears, dislocations, bone fractures, and total joint replacement.
• Pediatrics: This specialty specifically treats infants, children, and adolescents. Children with congenital birth defects, developmental delays, cerebral palsy, and spina bifida are among those commonly treated by pediatric PTs.
• Sports: These specialists work with athletes, both professional and non-professional, to return them to their pre-injury condition. Common sports injuries include ACL tears, tennis elbow, hip flexor strain, rotator cuff tears, and meniscus tears.
• Women's health: This specialty focuses on conditions specific to or especially common in females, such as pelvic floor dysfunction, pelvic pain, stress incontinence, and osteoporosis. They can also provide postnatal treatment and aid with recovery from breast cancer surgery.
  

Preparing for an Appointment

Arguably, the most difficult part about working with PTs is finding one. One of the easiest ways to do so is to ask for a referral from the physician, nurse practitioner, or specialist treating you. Be sure to check that they are an in-network provider with your health insurer to avoid excessive out-of-pocket costs.

You can also use the online locator offered by the American Physical Therapy Association to find a PT nearest you. Once you have found a PT who suits your needs, do not hesitate to ask about their qualifications, areas of expertise, certifications, and experience.

When preparing for your first appointment, be sure to:

• Arrive early: Your PT will likely have paperwork that you'll need to complete. These may be accessed beforehand through the practitioner's website. If you have a workplace injury or an insurance claim, bring the claim number and contact information of the insurance adjuster.
• Dress comfortably: In general, be prepared to move around a lot. Wear clothing that's easy to move around in. If you have upper body pain, wear a shirt that allows your shoulder, arm, or back to move freely. Shorts should be worn if you have hip, knee, or ankle pain.
• Provide details: During the initial visit, your PT will review your medical history and ask about your symptoms, capabilities, limitations, and goals. If you have medical reports relevant to your condition, bring them. You should also make prepared notes so you don't forget anything.

The relationship with your physical therapist should feel like a partnership. If you have questions about any part of your treatment plan, just ask. Your PT should encourage questions and be able to provide clear, concise answers.

The more that you understand about your treatments—what they do and why they are used—the more likely you will be to achieve your desired goal.

Summary

Physical therapists are licensed allied health professionals who have undergone three years of training to attain a doctorate degree in physical therapy. They are qualified to assess and treat injuries, disabilities, or other health conditions that affect mobility, physical function, and the overall quality of life.

Treatment plans typically involve exercise and a variety of therapeutic modalities, such as massage, ultrasound, cold/heat therapy, electrical stimulation, and electrophoresis. Some PTs embark on board-certified specialties such as geriatrics, pediatrics, oncology, and women's health.